Well, I guess I'll jump in on this one since no one else has. There are several "pros" and several "cons" for certain. I will just throw out a few that I think exist.
For pros:
1. I think you get to work with more qualified people who are more interested in teaching. The thing that attracts faculty to University hospitals is the opportunity to do research and teach residents and students. These faculty that are doing the cutting edge research are, in my opinion, inherently more qualified to teach than the local attending at the community hospital.
2. The availability of a wider array of rotations from which to choose. It's gonna be hard to get that Peds Endocrine (or whatever other specialty) rotation at the community hospital.
3. The side benefits. For example, our program gets to use the facilities of the local university. We actually work the football games for UT so 4-8 residents attend each home game for free. We get to use the exercise/recreational facilities of the university as well. For example, UT has outdoor rec equipment available for rent at a nominal fee, things like kayaks and tents and other equipment. Also we get to use the aquatic center, the rock climbing wall, and any other facilities. We also get access to the enormous library on main campus and we get the UT discount on computers and software and stuff like that. We even get the UT discount on cell phones, which amounts to 15% off on Verizon if you have that service. All those little things add up.
4. Stronger didactics. We have one hour lectures 5 days a week and often times the speaker is one from another department here at the university or sometimes a specialist from another institution. We also have a good number of FM faculty here so we get quite a few lectures from our own faculty as well. I think smaller programs with fewer faculty would probably not be able to provide as strong a program in didactics.
5. More opportunity to get involved in research for those that would desire that type of thing.
Cons:
1. If the university harbors a large amount of residency programs, then FM can get squeezed for procedures. You can protect yourself against this by choosing the program wisely. For example, our program has only about 10 residency programs. Of those 10 or so, about half are not specialties where FM would compete for procedures, things like path, rads, medical genetics, OMFS, anesthesia, etc. Of the ones that would compete with FM for procedures, the OB/Gyn dept here is only three residents per year so they are always swamped and glad to have FM residents around to help out with the work load, and the IM dept here is not exactly high powered as it does not have a single fellowship program. So far my procedural experience is second to none. I am only half way through my intern year and I already have privileges to place chest tubes, central lines, do circumcisions, do OB ultrasounds and a number of other procedures without direct faculty supervision. But, I have always made it clear that I want to do any procedures that are available.
2. You may not get as much one on one face to face time with faculty as you would at a small community program.
Anyway, I guess it's not to hard to decipher my take on this one. As always, take any advice in it's context. What's right for one may not be right for another